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    Commuter Card Handling Form - CCHF

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    1hope819
    This document provides instructions for completing a Commuter Card Special Handling Form. It explains that the form should be used to request reimbursement for commuting expenses when the commuter card cannot be used. It lists acceptable reasons for reimbursement requests and provides tips for accurately filling out the form and including necessary receipts. Employees are instructed to submit separate forms for each month, sign the form, retain a copy, and either fax or mail the completed form within 180 days of the benefit month.

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    Commuter Card Handling Form - CCHF

    Uploaded by

    1hope819
    91 views2 pages
    This document provides instructions for completing a Commuter Card Special Handling Form. It explains that the form should be used to request reimbursement for commuting expenses when the commuter card cannot be used. It lists acceptable reasons for reimbursement requests and provides tips for accurately filling out the form and including necessary receipts. Employees are instructed to submit separate forms for each month, sign the form, retain a copy, and either fax or mail the completed form within 180 days of the benefit month.

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    This document provides instructions for completing a Commuter Card Special Handling Form. It explains that the form should be used to request reimbursement for commuting expenses when the commuter card cannot be used. It lists acceptable reasons for reimbursement requests and provides tips for accurately filling out the form and including necessary receipts. Employees are instructed to submit separate forms for each month, sign the form, retain a copy, and either fax or mail the completed form within 180 days of the benefit month.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    91 views2 pages

    Commuter Card Handling Form - CCHF

    Uploaded by

    1hope819
    This document provides instructions for completing a Commuter Card Special Handling Form. It explains that the form should be used to request reimbursement for commuting expenses when the commuter card cannot be used. It lists acceptable reasons for reimbursement requests and provides tips for accurately filling out the form and including necessary receipts. Employees are instructed to submit separate forms for each month, sign the form, retain a copy, and either fax or mail the completed form within 180 days of the benefit month.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    COMMUTER BENEFITS

    www.wageworks.com Commuter Card Handling Form


    • Toll-free Fax: 877-353-9236
    • Or mail to: WageWorks Processing Center,
    Attn.: Special Handling, PO Box 60010, Phoenix, AZ 85082

    WAGEWORKS COMMUTER CARD SPECIAL HANDLING FORM INSTRUCTIONS


    PLEASE READ BEFORE SUBMITTING YOUR FORM
    Your claim is important, but in order for us to process it and your reimbursement quickly and fully, we
    need you to completely and accurately fill out and submit the WageWorks Commuter Card Special Handling
    Form (CCSHF). To help you, we’ve provided the below guidelines. Please follow them when completing and
    submitting your claim.

    Tips for Filling out the Commuter Card Special Handling Form
    •• Complete a separate form for each card.
    •• Read every box and provide all requested information pertaining to you and your claim.
    •• Provide the legal name your employer has for you in your official records, not your nickname.
    •• Make a copy of this completed form and your receipt for the out of pocket expense or the front and back of
    the pass (that shows the cost of your pass) and retain it until you are reimbursed or receive your credit.
    •• Submit your request within 180 days of the benefit month of your claim.
    •• Make sure you sign the form.

    Things to Remember When Including Receipts


    •• Include a receipt for the out-of-pocket expense or pass.
    •• A canceled check is not an acceptable form of receipt.
    •• Each receipt must include the date(s) of service.
    •• Do not send original receipts; keep them for your own records.
    •• If you attach multiple receipt pages, circle or check the dollar amount that is being claimed for each
    receipt.
    •• Do not use a highlighter to highlight the dollar amount on the receipt.

    Tips for Submitting the Commuter Card Handling Form by Fax


    •• Do not use a cover page.
    •• Fax OR mail this form; do not do both.
    •• Do not combine and submit a coworker’s claims with yours.
    COMMUTER BENEFITS
    www.wageworks.com Commuter Card Handling Form

    • Toll-free Fax: 877-353-9236


    • Or mail to: WageWorks Processing Center,
    Attn.: Special Handling, PO Box 60010, Phoenix, AZ 85082

    ACCOUNT HOLDER INFORMATION

    Last Name First Name

    ID Code (last 4 digits)* Employer / Program Sponsor’s Name

    Zip Code Birth Month/Day (MM/DD) Email address (complete only if new)

    CERTIFICATION AND AUTHORIZATION


    My signature certifies that the information on this page is correct and complete.
    Signature of Account Holder X___________________________________________________________ Date____________________________

    ABOUT YOUR COMMUTER CARD

    Name of Service Provider


    Transit Card $
    Parking Card
    Benefit Month (MM|YY) Amount
    , .
    REQUEST FOR REIMBURSEMENT
    I want to be reimbursed. I had to pay for my commuting expenses out of pocket because I could not use my Commuter Card for the
    following reason (check one):
    I did not receive my Commuter Card by the first day of the benefit month.
    I paid my commuting costs for the month out of pocket. (I will be reimbursed for the amount elected for the benefit month,
    and that amount will be deducted from my card.)
    I have not paid for my monthly commuting expenses. (The funds will remain on my card for future use.)
    My service provider or vendor did not accept my Commuter Card.
    I paid for my monthly pass or parking out of pocket. (I will be reimbursed for the amount elected for the benefit month, and
    that amount will be deducted from my card. If my provider does not accept the Card, I should check the catalog in my online
    account for another option which my provider will accept.)
    I paid for up to two days of commuting costs out of pocket. (I will be reimbursed for any eligible commuting expenses for up to
    two days, and that amount will be deducted from my card.)
    My service provider or vendor did not accept my Transit Commuter Card because:
    They only accept cash.
    I purchased an annual pass.
    I purchased a senior/disabled pass that could not be purchased with my Commuter Card.
    I am an overseas employee commuting on a foreign transit system.
    My transit pass exceeds the amount I can load onto my Commuter Card AND my transit provider does not accept more than
    one form of payment.
    The card I received is damaged or defective. Per WageWorks instruction, I tried reusing the card, but it still did not work. (I will be
    reimbursed for the amount elected for the benefit month, and that amount will be deducted from my card.)
    I have enclosed my defective card AND I paid for my monthly commuting costs out of pocket. (My defective card will be closed
    and a new one will be mailed out to me.)
    I have not enclosed my defective card, but I paid for my monthly commuting costs out of pocket. (My defective card will be
    closed and a new one will be mailed out to me.)
    My employment was terminated and I want to be reimbursed for the amount of POST-tax funds available on my card. (I understand
    that pre-tax funds cannot be reimbursed through this program.)

    * Your ID Code is the last 4 digits of your Social Security Number, your Employee Number or other reference number assigned by your
    program sponsor. Please check the enrollment instructions provided by your program sponsor for more information about your ID Code. 3726 (08/2016)

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